Iwamoto Yasuo, Miyazawa Teruomi, Kurimoto Noriaki, Miyazu Yuka, Ishida Astuko, Matsuo Keisuke, Watanabe Yoichi
Department of Pulmonary Medicine, Hiroshima City Hospital, 7-33 Naka-Ku, Moto-machi, Hiroshima City, Hiroshima Prefecture, 730-8518 Japan.
Chest. 2004 Oct;126(4):1344-52. doi: 10.1378/chest.126.4.1344.
To assess the efficacy and complications of interventional bronchoscopic techniques in treating airway stenosis due to tracheobronchial tuberculosis.
Case series.
Respiratory care centers at two tertiary care referral teaching hospitals in Japan, Hiroshima City Hospital and Okayama Red Cross Hospital.
A total of 30 patients were admitted to the hospital with a diagnosis of tracheobronchial tuberculosis between January 1991 and January 2002. Of those 11 patients received interventional bronchoscopy, including stent placement, laser photoresection, argon plasma coagulation (APC), balloon dilatation, cryotherapy, and endobronchial ultrasonography (EBUS). One patient with complete bronchial obstruction underwent a left pneumonectomy.
Six patients underwent stent placement after balloon dilatation, while the remaining five patients underwent only balloon dilatation. In six patients, Dumon stents were successfully placed to reestablish the patency of the central airways. Two patients first had Ultraflex stents implanted but had problems with granulation tissue formation and stent deterioration caused by metal fatigue due to chronic coughing. Dumon stents then were placed within the Ultraflex stents after the patient had received treatment with APC and mechanical reaming using the bevel of a rigid bronchoscope. In four patients, EBUS images demonstrated the destruction of bronchial cartilage or the thickening of the bronchial wall. The main complications of Dumon stents are migration and granulation tissue formation, necessitating stent removal, or replacement, and the application of cryotherapy to the granuloma at the edge of the stent.
Interventional bronchoscopy should be considered feasible for management of tuberculous tracheobronchial stenosis. Dumon stents seem to be appropriate, since removal or replacement is always possible. Ultraflex stents should not be used in these circumstances because removal is difficult and their long-term safety is uncertain. EBUS could provide useful information in evaluating the condition of the airway wall in cases of tracheobronchial tuberculosis with potential for bronchoscopic intervention.
评估介入性支气管镜技术治疗气管支气管结核所致气道狭窄的疗效及并发症。
病例系列研究。
日本广岛市立医院和冈山红十字医院这两家三级医疗转诊教学医院的呼吸护理中心。
1991年1月至2002年1月期间，共有30例诊断为气管支气管结核的患者入院。其中11例患者接受了介入性支气管镜检查，包括支架置入、激光光凝切除术、氩等离子体凝固术（APC）、球囊扩张术、冷冻疗法和支气管内超声检查（EBUS）。1例完全性支气管阻塞患者接受了左肺切除术。
6例患者在球囊扩张后进行了支架置入，其余5例患者仅接受了球囊扩张。6例患者成功置入了杜蒙支架以重建中央气道的通畅性。2例患者首先植入了Ultraflex支架，但因慢性咳嗽导致金属疲劳，出现肉芽组织形成和支架恶化问题。在患者接受APC治疗并使用硬支气管镜斜面进行机械扩孔后，在Ultraflex支架内放置了杜蒙支架。4例患者的EBUS图像显示支气管软骨破坏或支气管壁增厚。杜蒙支架的主要并发症是移位和肉芽组织形成，需要取出或更换支架，并对支架边缘的肉芽肿进行冷冻治疗。
介入性支气管镜检查对于结核性气管支气管狭窄的治疗应被视为可行。杜蒙支架似乎是合适的，因为总是可以取出或更换。在这些情况下不应使用Ultraflex支架，因为取出困难且其长期安全性不确定。EBUS在评估有支气管镜干预可能的气管支气管结核病例的气道壁状况时可提供有用信息。
